Shinkai H, Kimura W, Muto T
First Department of Surgery, University of Tokyo, Japan.
Am J Surg. 1998 Feb;175(2):114-7. doi: 10.1016/S0002-9610(97)00262-6.
To determine which polyps of the gallbladder should be operated upon, we investigated the size and number of polyps in resected gallbladders, and studied changes in gallbladder polyps using ultrasonography (US).
We studied 74 resected gallbladders with small polypoid lesions less than 20 mm in diameter, and 60 patients with gallbladder polyps by US. The polyps in resected gallbladders were classified into four groups histologically, and clinical features, maximum diameter, and number of lesions were compared among the groups. In the followed-up cases with gallbladder polyps, the size and number of polyps were examined by US, and changes during the observation period were studied.
The mean diameter of adenoma was 6.00 +/- 3.39 mm (mean +/- SD) and that of cancer 10.8 +/- 4.16 mm; 97% of cholesterol polyps were less than 10 mm in diameter (3.66 +/- 2.68 mm). Neoplastic polyps tended to be single (adenoma, n = 1.40 +/- 0.89; cancer, n = 1.16 +/- 0.40), whereas half of the cholesterol polyps were multiple (n = 3.09 +/- 3.31). However, when there were fewer than 3 lesions, the incidence of neoplasm was 37% among polyps 5 to 10 mm in diameter. A low incidence (6%) of neoplasm was also observed among polyps less than 5 mm in diameter.
These data indicate that an aggressive surgical approach for small gallbladder polyps is warranted when there are fewer than 3 polyps, regardless of their size.
为了确定哪些胆囊息肉需要进行手术，我们研究了切除胆囊中息肉的大小和数量，并使用超声检查（US）研究胆囊息肉的变化。
我们研究了74例直径小于20mm的小息肉样病变的切除胆囊，以及60例通过超声检查的胆囊息肉患者。将切除胆囊中的息肉进行组织学分类，并比较各组的临床特征、最大直径和病变数量。在胆囊息肉的随访病例中，通过超声检查息肉的大小和数量，并研究观察期内的变化。
腺瘤的平均直径为6.00±3.39mm（平均值±标准差），癌的平均直径为10.8±4.16mm；97%的胆固醇息肉直径小于10mm（3.66±2.68mm）。肿瘤性息肉倾向于单发（腺瘤，n = 1.40±0.89；癌，n = 1.16±0.40），而一半的胆固醇息肉是多发的（n = 3.09±3.31）。然而，当病变少于3个时，直径5至10mm的息肉中肿瘤的发生率为37%。直径小于5mm的息肉中也观察到低发生率（6%）的肿瘤。
这些数据表明，当息肉少于3个时，无论其大小，对小胆囊息肉采取积极的手术方法是必要的。
